Organization
ALLINA HEALTH SYSTEM
Active
Other names
Allina Health Weight Management-Mercy
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINICO TALLARICO (COO)
(612) 222-2222
Entity
Organization
Contact information
Practice address
11850 BLACKFOOT ST NW STE 130, COON RAPIDS, MN 55433-2583
(763) 236-2045
(763) 236-2044
Mailing address
PO BOX 43, MAIL ROUTE 10860, MINNEAPOLIS, MN 55440-0043
(612) 262-1166
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
01/27/2011
Last updated
03/21/2024
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